Peeling back the facts on the cruelest cut of all

Snippets of information wafting into Japan suggest that it may be about time to cut out the long-held belief that circumcision is vital for men's health, one of the country's top urologists tells Shukan Gendai (10/1).

Phimosis is the word used to describe the condition where the foreskin can't be pulled back over the top of the glans, and it's long been a topic of discussion in Japan's weeklies. Common belief here has it that the problem can easily be solved through circumcision, but growing numbers of Japanese physicians are arguing that it's no longer necessary to inflict the cruelest cut of all to solve the condition.

It's a big mistake to have made phimosis such a problem in the first place. Medically, there's absolutely nothing wrong at all, Eiji Ishikawa, head of the Ishikawa Clinic and one of Japan's most prominent urologists, tells Shukan Gendai. Actually, phimosis is more like the natural condition and there're more health problems involved when lopping off the foreskin. Western views on this condition have changed drastically over the past 30 years.

There are two types of phimosis. One where the foreskin can be peeled back under certain conditions and the other where it remains like a hood no matter what happens. In the latter case, circumcision is the only answer, but for the vast majority of cases -- Ishikawa says only about seven in every 10,000 cases require surgery – it should be left alone. Even so, demand for operations – effectively circumcisions performed on boys and men instead of babies – remains extremely high in Japan.

We get loads of mothers coming into the clinic asking for their sons to be snipped. They say things like It looks awful, He'll be ashamed to grow up and still look like this, It's unclean, and All the other moms from daycare say they can peel their sons' back,  Ishikawa says, adding that most of his patients are now middle-aged instead of the younger men who once sought the procedure. Up until recently, grown adults seeking circumcision had largely been in their 20s and 30s. Most of them had just found a girlfriend and were terrified that they would be exposed for being unable to expose the tip of their penis. Now, though, most of the people seeking help are already married. I've even had one guy who said he wanted his foreskin cut off because he was embarrassed that other members of his golf club would be able to see it.

Circumcision has a millennia-old history, with even Egyptian mummies from 4,000 years BC showing that they had undergone the cut. Apart from religious regions, the main reason it remains practiced today is because of archaic beliefs carried over from Victorian times.

It's mainly about preventing masturbation. The belief was that circumcised men masturbated less. In 19th century Europe and the United States, masturbation was blamed for a whole variety of ailments such as memory loss, laziness, tuberculosis, heart disease, paralysis and attention disorder, Ishikawa tells Shukan Gendai. But the urologist argues that, from a medical viewpoint, circumcision can be dangerous.

Cutting off the skin at the tip can destroy nerve endings that are every bit as sensitive as places like the fingers and the tip of the tongue, he says. Ishikawa argues that it has become common now in some countries for circumcised men to try and regenerate their foreskins.

Other experts aren't convinced that attitudes can change so easily.

Phimosis in Japan is probably a lot more mental than physical, Hideo Yamanaka, head of the Toranomon Hibiya Clinic in Tokyo, says. I had one guy in his 70s ask me for a circumcision because he couldn't stand the idea of somebody seeing he had phimosis even after he'd died.

Ishikawa reluctantly agrees.

Japanese men's phimosis phobia has fairly deep roots, he tells Shukan Gendai. Some people have even been driven into depression by it. In those cases, I think it's probably a better idea to circumcise.

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